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Article Excerpt
This article examines the work behaviors related to counseling substance-abusing clients by mental health service providers in multiservice mental health agencies. The results support the need for specialized knowledge and skills in working with substance-abusing clients.
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Treatment for individuals who abuse substances takes place primarily in two general settings: substance abuse treatment facilities and community multiservice mental health centers (Brown, Gfrere, Thompson, & Bardine, 1985; National Institute on Drug Abuse, 1982). Substance abuse treatment facilities work specifically with clients and their significant others on issues involving the use of substances, whereas community multiservice mental health centers deal with a much broader range of client concerns. Therefore, multiservice mental health agencies have an important role in providing services to substance-abusing clients (Volpicelli, 1997).
According to the U.S. Department of Health and Human Services 1998 Substance Abuse and Mental Health Sourcebook, 15.9% of clients seen at mental health agencies presented with substance abuse disorders. Reiger et al. (1990) found that substance abuse disorders, including alcohol, tobacco, and illicit drugs, were among the most frequently occurring mental health problems. Googins (1984) indicated that 1 out of every 10 clients in human service agencies potentially may need substance abuse services, and an additional 20% to 40% have been directly affected by someone who is a substance abuser. In addition, Volpicelli (1997) reported that 25% of alcoholics also have anxiety disorders, 20% to 40% of alcoholics experience depression, and 25% of all suicides are committed by individuals who have chronic alcohol dependence. Also, substance abuse is implicated for many clients who have other psychological or emotional disorders. Miller and Brown (1997) made the case that mental health service providers need to have knowledge and skills in the area of substance abuse because of the amount of substance abuse observed in the general clinical population.
Hosie, West, and Mackey (1988) studied 287 agencies that were accredited by the Joint Commission on Accreditation of Hospitals and that provided services for substance-abusing clients and found many employment opportunities for professional counselors in these facilities. Employment opportunities also exist in general multiservice mental health agencies for professional counselors to work with substance-abusing clients in general multiservice mental health agencies. Many counselor preparation programs have responded to the need to train counselors to work with substance-abusing clients by adding course content concerning substance abuse (Hollis, 1997). However, there remains a lack of knowledge regarding the substance abuse counseling responsibilities of general mental health service providers. Furthermore, Miller and Brown (1997) indicated that a serious omission in clinical settings is "the failure to recognize, assess, and effectively treat substance use disorders" (p. 1270). Counselor preparation programs have been forced to rely solely on educated judgments about the knowledge and skills that are needed by mental health counselors who work with substance-abusing clients.
Generally, researchers and educators tend to agree that basic knowledge and skills are imperative in counseling substance-abusing clients (Hosie et al., 1988; Levy, 1964; Stanton, 1988). However, clarification is needed concerning the nature of the work of professional counselors and other mental health service providers in multiservice mental health agencies who deliver services to substance-abusing clients. Systematically collected data that describe the actual practice of counseling substance-abusing clients could provide counselor educators with a framework of the relevant knowledge and skills that need to be incorporated into a counselor education curriculum. Professional counselors would then be more adequately prepared for employment in multiservice mental health agencies.
Investigations related to counseling substance-abusing clients have focused primarily on substance abuse specialty counselors in substance abuse treatment facilities. Although the knowledge gained from these studies has been helpful in providing the necessary model for specialized training because they were initiated for credentialing or certification purposes (Birch & Davis Corporation, 1984; National Certification Reciprocity Consortium/Alcohol and Other Drug Abuse [now the International Certification Reciprocity Consortium/Alcohol and Other Drug Abuse], 1992), the work of professional counselors in counseling substance-abusing clients in multiservice mental health agencies was not specifically addressed. One way to assess the parameters of substance abuse training and to systematically collect the needed data is to analyze the work behaviors of agency counselors during substance abuse counseling. A work behavior analysis, which is an investigation of the general structure of work activities performed by individuals in the same job position (Lopez, Kesselman, & Lopez, 1981), would provide a realistic perspective of counseling substance abuse clients within multiservice mental health agencies, as well as information concerning the critical skills related to substance abuse counseling needed by professional counselors seeking employment in these agencies.
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